The Enhanced Doctor-Chapter 606: Does actually have a sickness?

(Thank you to Papaya Duke, Northern Old Night Wolf, Wan Wan, Feng Lanqi Yi, Northern Old Night Wolf, Reader 160712150011189, Mom’s Here Run, Naughty Dragon 1976, Gong Xiaxue, bxby, Reader 20190506233558443, Lonely Star of Heavenly Moon, 1BODYGUARD1, Self-Pity Poem Wine Slim, Silent Little Guard, Dragon’s Messenger, Yi Yi Myth, Clear As Iron 83 for their monthly ticket encouragement.)

"Brother Wang, this is the situation. We need your guidance. Can you shed some light on why this spleen has enlarged?"

After Wang Huan finished his meal, Liu Banxia and Wei Yuan sought him out together.

Wang Huan looked helplessly at the two of them. "Without a more detailed examination, it’s hard to make any judgment. Does the patient have any other symptoms? Any pain elsewhere? In her chest, abdomen, back, or legs?"

Wei Yuan shook his head. "No issues elsewhere; we just checked again. The sweet and sour spare ribs her husband cooked seemed pretty good; she finished them all."

"Currently, her appetite and mood are completely normal. She has no physical discomfort whatsoever. To put it simply, apart from her slightly enlarged spleen, there are no other problems."

"If there were issues with the liver and gallbladder, there should be some signs of jaundice, right? We didn’t find any. If it’s a neurological issue, there should be some abnormal behavior, and we didn’t find any of that either."

"So, what else can we check?" Wang Huan furrowed his brow.

"It’s not muscle weakness. Could it be the early stages of Huntington’s Disease, causing her clumsiness due to a mild movement abnormality?"

Liu Banxia frowned, thought for a moment, then shook his head. "If that were the case, there would definitely be signs in her daily life. Even the slightest issues would have been noticed by her husband."

"Then I really don’t know what else to check," Wang Huan said. "The only thing left, as you’re considering, is to do a tumor marker screen. If that doesn’t yield anything, we might need to perform a lumbar puncture and check for NMDA antibodies and signs of encephalitis."

"She has no underlying conditions. If both of these tests also come back negative, then I believe we can consider her anemia, splenomegaly, and clumsiness to be unrelated conditions."

"That is to say, the anemia might be causing some physical weakness, leading to the clumsiness."

"As for the splenomegaly, it isn’t very pronounced at the moment, and there are so many potential causes. Unless it’s some rare disease, I truly don’t see a connection."

"Normally, if other diseases caused splenomegaly, how could it only enlarge by this much? It’s very likely her spleen was proportionally larger than normal to begin with, especially since we don’t have any previous scans for comparison."

"If you’re really worried, you might need to conduct a laparoscopic exploration to get a closer look at the spleen. Based on the current test results, it’s hard to make a judgment."

Liu Banxia nodded; Wang Huan’s opinion was pretty much in line with their own thinking.

The main issue was that there were many potential causes, and this patient’s splenomegaly wasn’t that obvious.

When diagnosing splenomegaly, unless it’s a severe case that is visually apparent or can be palpated during a physical examination, diagnosis mostly relies on imaging studies.

This patient had mild swelling. Measured along the standard lines—from the intersection of the left midclavicular line and the left costal margin to the lower edge of the spleen—it wasn’t even one centimeter.

If this patient didn’t have anemia and hadn’t reported clumsiness, such a scan would probably just result in a simple advisory note before she was sent home.

The various organs within the human body can very likely exhibit some individual variations. Unless there are previous spleen images for this patient for comparison, this current scan can only serve as a reference.

There’s also a high chance that, despite the system issuing them a task, it doesn’t mean the task indicates an actual disease. It was likely triggered simply by Wei Yuan’s consultation request.

The two of them returned to the patient’s bedside, where the couple was chatting.

"How are you feeling now?" Liu Banxia asked with a smile.

"I’ve eaten and had plenty to drink; it’s just that the wound on my hand hurts a bit," the patient replied.

"That’s normal. Don’t press on the wound, and don’t get it wet," Liu Banxia said.

"We discussed your case, and currently, we don’t have a clear direction, so we’re going to use a process of elimination. First, we’ll do a tumor marker screen to see if there’s any potential, undetected tumor."

"Doctor, are you saying I have cancer?" The patient suddenly grew anxious.

"You misunderstood. We’re just doing a screening to rule things out." Liu Banxia mustered the gentlest smile he could.

"Because based on the current test results, you only have anemia and an enlarged spleen. We’ve eliminated many causes, and your blood tests were all normal, right?"

"So we need to do further investigations. But my gut feeling is that you’re probably very healthy. The enlarged spleen might just be an incidental finding."

The patient frowned. Although Liu Banxia denied she had cancer, something still felt off. This wasn’t how it was supposed to be.

Doesn’t that mean I’m just making things up? Claiming to be sick when I’m actually fine?

"All the tests we do are essentially to rule out possibilities," Liu Banxia continued.

"If the tumor marker screening is negative, we’ll proceed with a lumbar puncture to examine the cerebrospinal fluid, checking for any subtle intracranial inflammation."

"That’s also a possibility. In the early stages of some types of inflammation, even though it has started to affect the body, the immune system may not have kicked in yet."

"If we still can’t detect any problems, we’ll consider involving a neurologist. Our neural conduction is achieved through bioelectric stimulation. We’ll need to monitor it closely to see if a certain neural pathway is having trouble transmitting signals."

"That’s all we can think of for now. You might be confused and feel like we’re being perfunctory, just running tests on you for fun. But that’s not the case at all. If that were true, you’d have a lot more payment receipts in your hand by now."

The patient nodded with a smile. "I see. So you’re also unsure about my condition. It’s like a multiple-choice question: you rule things out one by one. And with what’s left, you can make an educated guess, right?"

Liu Banxia also laughed. "Exactly, that’s the idea. But I can’t put it like that; it would make me sound unprofessional."

"Haha, alright, let’s go with your plan," the patient said with a laugh. "Just try not to take too much blood—I just ate those ribs to build my blood back up, and I plan to eat more tomorrow!"

"Don’t worry, we only take as much as is necessary for the tests. Keep up this positive attitude. People with a good attitude are generally less troubled by illness," Liu Banxia replied.

"Meanwhile, we also need to strive to take fewer detours on this path of educated guessing and figure out your condition. Would you mind if I chat with your husband for a few minutes? As an observer, he might have clearer insights."

The patient nodded. "Go ahead. Do I need to go to the ward?"

"No need, that would cost you extra. You’re currently under observation, not formally admitted to the hospital yet," Liu Banxia said.

"The weather is nice now, and we have floor heating here. There might be some noise at night due to emergencies, but the chances are slim."

The patient nodded, in a rather good mood—after all, nobody likes to throw money away unnecessarily.

"Hello, has she been exhibiting any signs of clumsiness at home?" Liu Banxia asked.

The patient’s husband thought for a bit, then nodded. "Occasionally, she doesn’t catch things I throw to her. Does that count?"

"Hmm... Let’s count it for now. Anything else?" Liu Banxia probed further. 𝑓𝓇𝘦ℯ𝘸𝘦𝑏𝓃𝑜𝘷ℯ𝑙.𝑐𝑜𝓂

"Nothing else. At home, she just snacks and watches TV; I do all the housework. But she does tend to kick things, so I don’t dare put anything near the sofa anymore," the patient’s husband revealed.

"Okay, that’s some information for us to consider. It seems like you’re the one running the show at home; I really need to learn from you," Liu Banxia joked.

"Ah, when you’re a couple, you both do things for the family. No need to be so particular about who does what," the patient’s husband commented. "Besides, I wouldn’t trust her with chores; she tends to do a slapdash job."

"Haha, you’re a true role model," Liu Banxia replied. "Please go back and be with her. We’ll try to figure out her condition with the fewest tests possible."

The patient’s husband nodded, then wandered back to his wife.

"It seems we can’t get much useful information from the patient or her family; we’ll have to find out on our own," Liu Banxia commented.

Wei Yuan nodded. "You really do dare say anything."

"Haha, I tailor my approach to the person," Liu Banxia retorted. "Would I dare say this to a particularly difficult patient?"

"However, sometimes the most cooperative patients turn out to be the most difficult when it comes to ordering instrumental tests. We can’t help but think twice about whether a test is necessary and whether it would cause them unnecessary burden."

"Do you really think it could be a neurological issue?" Wei Yuan wondered.

Liu Banxia shook his head. "That was just something I said offhand. It’s pretty much the last thing we’d consider, right? When we can’t detect any physical abnormalities or symptoms, then a neurological issue is the only thing left to consider."

"However, if it comes to that, we’ll need to consult with the neurology experts, establish a proper diagnostic procedure, and then order instrumental tests. Honestly, I can’t be certain whether this patient is actually ill, so I’m really conflicted about it."

Wei Yuan gave him a look and nodded in agreement.

Actually, if the patient hadn’t insisted, he would have discharged her right after finishing the sutures.

Even though they’d now identified two "symptoms," they weren’t definitive indicators of any specific disease. That was why he’d asked Liu Banxia for a consult—to help him cover all the bases.